Looking after our elderly

FLYING below the radar during all the fuss about the ‘Golfgate’ controversy last week was a very important report by the Nursing Homes Expert Panel that looked into the impact of Covid-19 on the sector and came up with 86 recommendations for improvement and better integration between the public and private spheres. As with all improvements that are required, this will inevitably involve extra government finance and it begs the question as to whether there would be better value to be got out of financing more home care packages for the elderly than there is in putting people into nursing homes too soon.

Reacting to the report, Seán Moynihan, CEO of the charity ALONE, while acknowledging the valuable role of nursing homes for older people with complex needs, intimated that they should not be going into them until absolutely medically necessary and that they should be given the choice and opportunity to age at home, which would ease pressure on acute medical services.

Providing a statutory right to home care, he said, would prove significantly cheaper compared to nursing home care, as it is a fraction of the cost; for example, €160 per week compared to over €1,500 for nursing home care. However, the waiting list for home care continues to grow, with around 8,000 people currently in need of home care, and there are practical considerations right now around going into people’s homes during the pandemic.

People stuck in hospitals have been prematurely moved to nursing homes because they could not avail of the necessary supports to live in their own home, so urgent investment in home care and community housing services for an ageing population is vital. He also agreed that nursing homes need to be brought into line with wider health and social care infrastructure in Ireland, as the report recommends.

It also focussed on the funding of the ‘Fair Deal’ scheme, officially known as the Nursing Home Support Scheme, calling for extra funding to ensure nursing home adherence to HIQA’s nursing home standards and further ongoing costs arising from Covid-19. The report also recommends that increased integration of private and voluntary homes into the wider health system ‘requires enhanced transparency of operation, funding and finances of these nursing homes.’

How these homes are funded and spend both public and private money, the report continues, ‘should be clearly transparent and measures should be considered to ensure this.’ However, Drimoleague native Tadhg Daly, who is chief executive of Nursing Homes Ireland, took issue with the report on this, pointing out that the accounts and records of all nursing homes are submitted to National Treatment Purchase Fund around negotiation of fee rates, adding that ‘there is full transparency and they (the expert panel) are ill-informed in that particular recommendation.’

Me Daly opined that ‘the issue around the contribution in terms of Fair Deal was highlighted by the Comptroller & Auditor General, who stated it was the HSE where it was difficult to get a sense of budgets in their own units.’ The cost of HSE nursing home care is much higher than in private concerns and the Nursing Homes Expert Panel report recommended a review of employment terms and conditions of nurse and healthcare assistant staffing grades.

Having accounted for more than half of the number of deaths from Covid-19 in Ireland so far, it was clear that nursing homes were not prepared for the pandemic when it hit and it took too long for them to get the help they needed to deal with infection control. The report recommends several measures in this regard, including new patients only being admitted to nursing homes which can demonstrate their infection control measures are of a sufficiently high standard and that HIQA should maintain a register of those it deems to have reached these standards.

The expert panel would like that the ’flu vaccine would be made mandatory for staff in nursing homes, something that it may be difficult to enforce, and that staff should not be allowed work across multiple sites for the next 18 months until the pandemic is over.

Time and tide have caught up with the government after years of underfunding the ever-increasing demand for caring for our ageing population and the new Minister for Health, Stephen Donnelly, will have to step up to the plate and get more realistic about financing the challenges that lie ahead.

Otherwise, we – as a society – are failing to look after our elderly, who have made the biggest sacrifices of any demographic during the Covid-19 pandemic, properly and with the dignity they rightly deserve.